" It doesn't matter which Organization finds the Children,

 but how fast we find the Children."

"Medical Authorization"

I, the undersigned parent or legal guardian of a minor, do hereby authorize any law enforcement agency to use their judgment in obtaining medical treatment for my child. I give my permission to the medical, dental, or emergency room staff selected to render any emergency medical, surgical or dental treatment necessary. I understand that any costs incurred for my child for such emergency treatment shall be my sole responsibility. It is also understood that effort shall be made to contact the undersigned prior to rendering treatment to the child, but that none of the above treatment will be withheld if the undersigned cannot be reached.

Signature of
Parent or guardian___________________________________________________

Date ___________________________________________________________

Witness ________________________________________________________

Date ___________________________________________________________

Medical Insurance Co. _______________________________________________

Policy Number _______________________________________________________

Dental Insurance Co. ________________________________________________

Policy Number _______________________________________________________

Hospital _____________________________ Phone ( ) ____________________

Doctor _______________________________ Phone ( ) ____________________

Dentist ______________________________ Phone ( ) _____________________

Name of relatives or friends to be contacted in case of emergency
when I cannot be contacted.

Name _________________________________ Phone ( ) ______________________

Name _________________________________ Phone ( ) ______________________

Name _________________________________ Phone ( ) ______________________

When the above form has been completed, make photocopies and mail to your

Hospital, doctor, dentist and emergency care center for their record

" It doesn't matter which Organization finds the Children,

 but how fast we find the Children."